Manzione Carmen Ruth, Nadal Sidney Roberto, Calore Edenilson Eduardo
Department of Proctology, Emilio Ribas Infectious Diseases Institute, Sao Paulo, Brazil.
Dis Colon Rectum. 2003 Oct;46(10):1358-65. doi: 10.1007/s10350-004-6750-7.
The purpose of this study was to analyze the postoperative follow-up of HIV-positive patients with anal condylomata acuminata, associating recurrence to the AIDS status.
Ninety-seven male, homosexual patients with anal condylomata were submitted to surgical treatment from August 1992 to December 1997. Specimens were obtained for histologic investigation of Ki-67 cell proliferation marker and for polymerase chain reaction to define the human papillomavirus type. The patients were advised to return weekly during the first month, and monthly up to the sixth month, to evaluate recurrence. Patients with high-grade anal intraepithelial neoplasia remain in follow-up.
Histology revealed low-grade anal intraepithelial neoplasia in 81.44 percent of patients and high-grade lesions in 18.56 percent. The results showed that high-grade lesions were not more frequent in late-stage AIDS patients. Ki-67 expression, a cell proliferation marker, was greater in high-grade than in low-grade anal intraepithelial neoplasia, but had no association with AIDS status. Nononcogenic human papillomavirus 6 and 11 were the commonest types. Comparing papillomavirus types and anal intraepithelial grade, we noticed that both oncogenic and nononcogenic types were responsible for high-grade lesions. All patients healed and 51 (52.6 percent) had recurrence up to the sixth month. AIDS status and papillomavirus type were not associated with recurrence. However, high-grade anal intraepithelial neoplasia patients had more recurrence than those with low-grade lesions. Topical treatment failed in 20 patients (41.6 percent), and these were submitted to new surgical treatment. All of them were in the late stage of AIDS. Three who had high-grade lesions in the first operation had low-grade lesions in specimens from the second surgery. The same histologic pattern was observed in 17 patients who had low-grade lesions in warts removed in the first operation. Other patients with high-grade lesions had no recurrence or evolution to invasive carcinoma from five to ten years of follow-up.
High-grade anal intraepithelial neoplasia and late-stage AIDS are risk factors for recurrence of anal condylomata.
本研究旨在分析艾滋病病毒阳性的肛门尖锐湿疣患者的术后随访情况，并将复发情况与艾滋病病情相关联。
1992年8月至1997年12月，97例患有肛门尖锐湿疣的男性同性恋患者接受了手术治疗。获取标本用于Ki-67细胞增殖标志物的组织学研究以及聚合酶链反应以确定人乳头瘤病毒类型。建议患者在第一个月每周复诊，直至第六个月每月复诊，以评估复发情况。高级别肛门上皮内瘤变患者仍在随访中。
组织学检查显示，81.44%的患者为低级别肛门上皮内瘤变，18.56%为高级别病变。结果表明，晚期艾滋病患者中高级别病变并不更常见。细胞增殖标志物Ki-67的表达在高级别肛门上皮内瘤变中高于低级别，但与艾滋病病情无关。非致癌性人乳头瘤病毒6型和11型是最常见的类型。比较乳头瘤病毒类型和肛门上皮内瘤变级别时，我们注意到致癌性和非致癌性类型均与高级别病变有关。所有患者均愈合，至第六个月时51例（52.6%）复发。艾滋病病情和乳头瘤病毒类型与复发无关。然而，高级别肛门上皮内瘤变患者的复发比低级别病变患者更多。20例患者（41.6%）局部治疗失败，这些患者接受了再次手术治疗。他们均处于艾滋病晚期。首次手术时有高级别病变的3例患者在第二次手术标本中为低级别病变。在首次手术切除的疣体中有低级别病变的17例患者也观察到了相同的组织学模式。其他有高级别病变的患者在5至10年的随访中未复发或进展为浸润性癌。
高级别肛门上皮内瘤变和晚期艾滋病是肛门尖锐湿疣复发的危险因素。
